INTRODUCTIONThe US Food and Drug Administration (FDA) approved buprenorphine or Subutex for the treatment of opiate dependence in October 2002. Buprenorphine is a partial agonist of the mu-opioid receptor; although initial animal research suggested a low abuse potential for buprenorphine, it was subsequently shown to have an abuse potential similar to that of morphine or hydromorphone. The objectives of this study were to establish the sociodemographic profile and help-seeking behaviour of buprenorphine abusers attending the deaddiction treatment clinics of the Community Addictions Management Programme.

MATERIALS AND METHODSOne hundred and twenty subjects, all buprenorphine abusers fulfilling the diagnostic criteria for opiate dependence, who consented to the study, completed an interviewer-administered questionnaire.

RESULTSThe mean age of those participating in the study was 39.2 [standard deviation (SD) 8.0] years. The majority of the participants were male (90%), 52.5% were currently employed and 98% had at least primary education. A family history of drug abuse was reported by 27% of the subjects. Illicit drug abuse occurred at an early age with mean age of onset of illicit drug abuse being 16.9 (SD 4.8) years with gateway drugs like marijuana and glue.

CONCLUSIONSIt is vital for our medical profession to be aware of the trend in the local population to move from the abuse of illicit substances, to the abuse of prescriptive medications. It makes it necessary to increase the understanding of addictions both amongst our practising medical fraternity, and amongst those training to enter the profession. At the hospital level, it necessitates a higher level of vigilance among our emergency room physicians and those treating infectious diseases.

Adult ; Buprenorphine ; Female ; Humans ; Male ; Middle Aged ; Narcotic Antagonists ; Opioid-Related Disorders ; rehabilitation ; Patient Acceptance of Health Care ; Singapore ; Socioeconomic Factors

INTRODUCTIONResearch suggests that methadone maintenance treatment (MMT) effectively reduces opiate dependence and related health and social problems. However, few studies have examined its effectiveness among the elderly. This study examined a monthly MMT regime for elderly opium addicts attending the National Addictions Management Service, Singapore.

MATERIALS AND METHODSThis study used a cross-sectional design and comprised 40 patients attending the addiction service and 40 caregivers who monitored methadone consumption (mostly patients' sons and daughters). Participants completed a semi-structured interview comprising measures of opiate craving and withdrawal, physical and psychological health. Objective measures were urine drug screens and blood tests.

RESULTSParticipants who averaged 74.8 years old had been using opium for around 44 years and had been in MMT for an average of 35 months. The maintenance dose of methadone was 9.2 mg/day. At interview, no opiate usage (other than methadone) was detected in urine screens; however, clinical records indicated that 6 had tested positive during the previous 6 months of MMT. No major withdrawal symptoms, side effects, or incidents of diversion were reported. Quality-of-life scores were in the normal range and satisfaction with the treatment regime was expressed by caregivers.

CONCLUSIONWhilst MMT is the predominant pharmacotherapy for opiate dependence for users of all ages elsewhere, our study group constitutes a unique population that differs markedly from younger opiate users who will eventually grow old. In Singapore, MMT appears to be an effective treatment for stable, elderly opium-dependent patients where families are fully engaged in the treatment regime.

Aged ; Caregivers ; psychology ; Cross-Sectional Studies ; Female ; Home Care Services ; Humans ; Interviews as Topic ; Male ; Methadone ; administration & dosage ; therapeutic use ; Opioid-Related Disorders ; nursing ; rehabilitation ; Quality of Life ; Singapore

Buprenorphine ; therapeutic use ; Humans ; Methadone ; therapeutic use ; Naltrexone ; therapeutic use ; Narcotic Antagonists ; therapeutic use ; Narcotics ; therapeutic use ; Opioid-Related Disorders ; rehabilitation

Objective: To investigate the association between three single nucleotide polymorphism (SNP) genes DRD2 (rs1800497, rs6275, and rs1799978) and the dosage used on methadone maintenance treatment (MMT). Methods: From the methadone maintenance treatment centers, 257 MMT patients were recruited to participate in a case-control study and divided into two groups-control groups under low dosage (n=89) and case (n=168) group with high dosage. Quanto software was used to estimate the sample size as 180. Information related to social-demographic status, history on drug use and medication were collected. And DRD2 SNPs were genotyped to explore the relationship between polymorphism of DRD2 gene and the dosage of methadone maintenance treatment. Results: Distributions of DRD2 rs6275 between different groups were significantly different. Patients carrying TC genotype needed lower dose of methadone when compared to the patients that carrying CC genotype counterparts (OR=0.338, 95% CI: 0.115-0.986). Patients that carrying C allele at rs6275 needed lower methadone dose than those that carrying genotype TT (OR=0.352, 95% CI: 0.127-0.975). Distributions of genotypes, alles in the other two SNPs (rs1800497, rs1799978) were not significantly different between groups under different dosages. Conclusion: DRD2 rs6275 was associated with dosage of methadone used for the MMT patients. However, no significant associations were found between rs1800497, rs1799978 and the dosage of methadone.
Alleles ; Case-Control Studies ; Drug Dosage Calculations ; Genotype ; Humans ; Methadone/therapeutic use* ; Opiate Substitution Treatment ; Opioid-Related Disorders/rehabilitation* ; Polymorphism, Single Nucleotide/genetics* ; Receptors, Dopamine D2/genetics*

OBJECTIVETo evaluate the effectiveness of the first eight pilot methadone maintenance treatment (MMT) clinics in China.

METHODSA questionnaire survey of the clients at the 8 pilot MMT clinics was performed at entry, 6 month and 12 month follow-up. Drug using behaviors, drug related crime behaviors, and relationships in families were compared among at entry, 6 and 12 months follow-up.

RESULTSThere were 585, 609 and 468 clients involved at baseline, 6 month and 12 month follow-up surveys, respectively. At entry, 6 month and 12 month follow-up, the proportion of clients whose injection of drugs reduced from 69.1% to 8.9% and 8.8%, and the frequency of injection in the past month had reduced from 90 times per month to 2 times per month. Employment rate increased from 22.9% to 43.2% and 40.6%, and self-reported criminal behaviors reduced from 20.7% to 3.6% and 3.8%. At 12 month follow-up, 65.8% of clients reported a healthy family relationship, increased from 46.8% at entry, 95.9% of clients reported that they were satisfied with the MMT service.

CONCLUSIONPilot MMT program reduced drug use, drug injecting behaviors, drug related criminal behaviors, and improved relationship with family members. Therefore, MMT clinic should be considered as a platform for providing comprehensive services to drug users.

Adult ; Analgesics, Opioid ; administration & dosage ; China ; Follow-Up Studies ; Humans ; Methadone ; administration & dosage ; Opioid-Related Disorders ; rehabilitation ; Outcome Assessment (Health Care) ; methods ; Program Evaluation ; methods ; Substance Abuse Treatment Centers ; organization & administration ; standards ; Surveys and Questionnaires

INTRODUCTIONBuprenorphine is an opioid partial agonist approved in several countries for the treatment of opioid dependence. It was approved in Singapore in 2002 for this indication, and is more widely available in the primary care setting and can be prescribed by all licensed physicians who have undergone designated training. There is limited literature addressing the risk of its illicit abuse via intravenous self-administration.

CLINICAL PICTUREWe report 2 such cases of the abuse of prescription buprenorphine in the psychiatric consultation-liaison service of a general teaching hospital, the treatment approaches and outcomes.

CONCLUSIONWe also briefly review the indications, uses and abuses of buprenorphine in Singapore, and as reported in other countries, and the roles of primary care physicians, in order to stimulate greater awareness and understanding among specialists and general practitioners, who would encounter these patients in various settings.

Adult ; Buprenorphine ; therapeutic use ; Drug and Narcotic Control ; Female ; Humans ; Male ; Narcotic Antagonists ; therapeutic use ; Opioid-Related Disorders ; rehabilitation ; Pregnancy ; Pregnancy Complications ; diagnosis ; therapy ; Primary Health Care ; Role ; Substance Abuse, Intravenous ; diagnosis ; prevention & control ; therapy